1. Assess airway, breathing, and circulation (ABCs) and vital signs.
2. Evaluate for hepatomegaly, pigmentation, short stature, and neurologic signs.
B. Laboratory Data. Careful history and physical exam usually provide clues to diagnosis. Patients with a history of hypoglycemia may require hospital admission to induce hypoglycemia and to obtain laboratory data during an acute episode.
1. Obtain serum glucose, insulin, cortisol, and growth hormone levels, and urinalysis for ketones. If possible, also obtain C-peptide, lactate, ammonia, thyroid-stimulating hormone, and thyroxine levels.
2. Serum electrolytes, renal and liver function studies, and CBC may be helpful in evaluating some of the causes listed under differential diagnosis, earlier.
C. Radiographic and Other Studies. May be indicated to evaluate for insulinoma, malignancy, and pituitary lesions if suggested by history, physical exam, or screening studies.
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